MEDICARE: CITY OF DAYTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590008510	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000021399	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265433130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF DAYTON

Provider Business Mailing Address
First Line	:	PO BOX 632458
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2458
Country	:	US
Telephone Number	:	888-449-8112
Fax Number	:	888-965-4620

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1208
Country	:	US
Telephone Number	:	888-449-8112
Fax Number	:	888-965-4620

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEFFREY PAYNE II
Credential	:
Telephone Number	:	937-333-4504

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/12/2019

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Directions to “CITY OF DAYTON ” Practice Location

Language	Start Address	Practice Location

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